Revision rhinoplasty is a nose operation performed to correct or revise an unsatisfactory outcome from a previous rhinoplasty. An unsatisfactory outcome occurs from 5% to 20% of rhinoplasties. There are two main reasons for performing secondary rhinoplasty. Patients often seek secondary rhinoplasty to correct a cosmetic deformity of the nose. A patient may be unsatisfied with all or part of a previous "nose reshaping." The reduction of the nasal fracture may be not enough, or too much. Inappropriate addressing of a prominent or bulbous nasal tip may have not been or over-aggressively. The nose looks pinched; it may look like a parrot's beak, or like a boxer's nose. Nose surgery may have left a nose aesthetically unappealing to a patient in many ways. Another reason for revision is functional. The original nasal surgery to help with difficulties in breathing and the outcome may have been unsatisfactory. Alternatively, the original cosmetic surgery disrupted a normal physiologic mechanism involving the inspiration or expiration of air, making it difficult to breathe. Secondary rhinoplasty is a procedure often said to be extremely complicated. Because the surgery may destroy or deform nasal framework, revision rhinoplasty experts frequently must reconstruct the support structures of the nose using cartilage grafts either from the ear or from rib cartilage. Advances in rhinoplasty techniques, such as stabilization of rib cartilage grafts and utilization of the open approach, now allow satisfactory results in secondary rhinoplasty.

Treatment Gap

The treatment gap is massive among those who need treatment for a substance use disorder and do not receive it. In 2007, 23.2 million people aged 12 or older required treatment for an illicit drug or alcohol use problem, but only 3.9 million received treatment at a specialty substance abuse facility. Reducing this gap requires a multipronged approach. Strategies include increasing access to effective treatment, achieving insurance parity, and reducing stigmas and raising awareness among both patients and health care professionals.

Michael Siegel

Michael Siegel has a deep interest in fine art, which dates back to his early childhood, and it was at the age of 14 that he took his first serious steps towards becoming a professional artist. He studied figure drawing and portraiture in Milwaukee and Los Angeles under such luminaries as James Prohl and Glenn Vilppu. The pivotal moment in his studies came in 1998, when at the age of 18 he attended a painting seminar taught by Gregg Kreutz of the New York Art Students' League, who introduced him to the chiaroscuro style of the old Dutch Masters. Since then, Michael has studied privately under the incomparable David Leffel, formerly of the Art Students League in New York, who is the 20th Century Old Master. "Painting, as a discipline, is governed by an inherently beautiful logic, and it is through the understanding of this logic that the painter can achieve beauty on the canvas." Born in 1979, the youngest son to a violinist father and artist mother, Michael grew up drawing from a very early age. With an interest in becoming an animator, Michael spent his high school years in Los Angeles studying anatomy and figure drawing under leaders in the field. It was not until the age of 18, however, when Michael went to his first painting workshop that he knew he had found his calling. Known now for his still life, portraiture and figure painting, Michael uses a dramatic "chiaroscuro" (or "light and shadow") approach to create powerful and moving paintings. At his young age, Michael earned honors at many national exhibitions, and galleries across the USA and the world have featured his work. Currently, Michael resides in Los Angeles. http://www.siegelfineart.com/